1250 Ocean Parkway

Suite LN

Brooklyn, NY 11230

(718) 500-3505

Dermatology

Surgery & Aesthetics

New Patient Intake Forms 

Telemedicine Consent form

Arbitration Agreement

HIPAA Notification

APPOINTMENT CHECKLIST:

Please bring the following items with you to your appointment:

• The new patient intake forms (link above) completed and signed. If possible, it is preferred that you email (contactus@vivedermatology.com) or fax (1-844-704-5854) them back to us  prior to your appointment. If you choose to complete the paperwork in the office, please arrive 15 minutes prior to your scheduled appointment time. 

• List of all current medications, including topicals and over the counter medications – name, dose and frequency

• Insurance card

• Driver’s license or other phote ID

• Valid form of payment ie. cash, Zelle, Venmo, credit card (Visa or MasterCard). Please note that all credit card transactions will incur a 3% convenience fee. 

• Any biopsy reports or pertinent medical records

• Name and phone number of your preferred pharmacy

OFFICE FINANCIAL POLICIES: 

Our office requires a credit card on file. This will be used to pay your portion of the bill once your insurance has processed your claim and leads to a dramatically more efficient billing process that most patients find convenient. The way this works is:

• Once your insurance company has paid their portion of your bill, they should send you an Explanation of Benefits (EOB) that outlines our charges for the services you have received, the contracted rate that you receive through your insurance, the amount your insurance company has paid, and the balance that your insurance company has determined is due to Vive Dermatology.
• After your insurance has processed the claim, we will send you a statement for any outstanding balance (patient portion).
• This balance will be charged to your credit card 2 weeks after the date of the statement.
• Prior to that 2 week deadline, you can send a check or make a payment online with a different card (Many people will pay online using their HSA card).
• We will contact you if your card does not process for any reason. 
•  Our practice has implemented stringent security measures to protect your credit card information.

If you choose not to provide your credit card authorization, you may leave a $250.00 deposit on your account instead. Any amount due of your account in excess of the deposit will be subject to a $25.00 statement fee per month for any outstanding balance over 30 days.

Please verify your insurance coverage prior to the appointment (i.e. deductible, co-pay, co-insurance, etc.). Even though we may be in network with your insurance, you may be responsible for a deductible, co-pay or co-insurance. While we attempt to aid patients in this process, it is ulitmately the patient's responsibility to be familiar with the plan they chose and purchased. Kindly understand that there are now hundreds of insurance plans and it is impossible for us to be familiar with the exact plan that each of our patients chooses. 

The patient is responsible for obtaining a valid referral from their primary care physician (PCP), if required by their insurance plan. If a valid referral is not obtained, the patient will be solely responsible for all visit charges.

OFFICE LATENESS, CANCELLATION AND NO-SHOW POLICIES:

If you need to cancel/reschedule, please call at least 24 hours prior to your appointment otherwise, you will be assessed a $50 fee for medical appointments and a $150 fee for cosmetic and procedural/surgical appointments. No-shows will be assessed the same fee. Sunday appointments should be cancelled by noon the previous Friday. 

We make every effort to stay on schedule and respect our patients' time. Therefore, if you arrive after your appointment was scheduled to begin, you will be seen but only for the amount of time remaining. If you are 15 minutes late, this will be considered a missed appointment. We will make every attempt to reschedule you into any available appointment slots that day.